During the last decades, mortality rates from coronary heart disease (CHD) have decreased, with more than 50% of the mortality reduction attributable to better control of traditional cardiovascular risk factors on a population level (primary prevention) [
1,
2]. Regarding the treatment of established disease, secondary prevention administered through cardiac rehabilitation (CR) is the major contributor to the mortality reduction [
3]. CR includes specific core components comprising baseline patient assessment, nutritional counseling, risk factor management, psychosocial interventions, physical activity counseling, and exercise [
4].
It is well documented that participation in CR programs improves risk factor control and therapy adherence, enhances quality of life, and reduces recurrent events [
5,
6]. However, the incomplete fulfillment of guideline-recommended CR targets is currently a matter of concern [
7]. In the latest annual report from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, it was shown that at 1 year after a myocardial infarction (MI) only 21% of patients reached the four main treatment objectives: abstinence from smoking, systolic blood pressure < 140 mmHg, low-density lipoprotein cholesterol < 1,8 mmol/L, and active participation in a supervised exercise program as a part of CR [
8]. One main barrier to target achievement is limited accessibility to CR programs [
9]. Also, while international recommendations advocate program flexibility and individual tailoring, most of the current CR programs are rigid and time-limited and demand substantial healthcare resources [
9,
10]. Therefore, all main international heart associations have claimed for the reengineering of CR to enhance access, adherence, and effectiveness. The general call is for the development of innovative and cost-effective CR programs that are oriented to modify lifestyle and behavior with sustainable results and may be easily integrated into the pre-existing healthcare structures [
9,
10]. eHealth, i.e., the use of electronic communication and information technologies in healthcare, offers a whole new array of possibilities to provide clinical care. These include, for example, distance monitoring via telecommunication and sensors, interactive computer programs, and smartphone applications. While there are thousands of available eHealth applications on the market, only a small minority have been tested in a controlled manner with proper guidance from healthcare personnel. This is crucial, as investment in new treatments and technologies in healthcare needs to be evidence-based [
11,
12]. The few published studies on eHealth solutions in CR, mostly using Internet and smartphone-based interventions, have reported enhanced self-management of risk factors with indications that the interventions have the potential to improve well-being, decrease risk for recurrent events, and increase adherence to medication [
13‐
17]. However, most of these studies have included only small numbers of patients with short follow-ups (weeks or months) and have investigated a reduced number of surrogate endpoints, limiting clinically useful conclusions [
18].
Aim of the study
The study will assess the efficacy of a web-based application as a complement to traditional CR programs for improvement of secondary prevention outcomes in post-MI patients, compared with usual care. The hypothesis is that the intervention will enhance patient adherence to lifestyle advice (exercise, daily physical activity, healthy diet, and tobacco abstinence) and medication, resulting in better risk factor control and prognosis as well as improved self-rated health.